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When Patients Say No: Rethinking Refusal in Bedside Medical Education
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ABSTRACT<sec> <title>Background

Bedside clinical teaching is a fundamental part of the medical education that offers invaluable opportunities for the students to build and improve their clinical and communication skills. However, there is a growing concern about the increasing refusal of patients to participate in clinical sessions, especially in certain settings where there are sensitive cultural traditions and decreased trust in institutions.

Aim

This paper discusses patient refusal during bedside clinical teaching and views it from three aspects, that of the medical student, the clinical educator and the patient, and proposes culturally sensitive strategies that balance patient autonomy with educational needs.

Perspective

Patient refusals reduce the students' chances of hands‐on learning, placing the educator under ethical strain and emotional fatigue. These refusals are not simply uncomfortable incidents, but they signal underlying systemic gaps such as lack of transparent communication with the patients, failure to adapt to the social development and deep cultural dissonance. While simulation offers partial relief, it cannot fully replace the human dimensions of real patient interactions.

Conclusion

Patients' reluctance is a meaningful message that needs to be heard. A thoughtful reform including coordinated efforts at the level of patient education, faculty support, student preparation and institutional policy is needed. Without reform, we risk graduating doctors who have never truly encountered the human side of medicine.

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Publication Date
Tue Oct 01 2024
Journal Name
Medical Journal Of Babylon
Association between Single Nucleotide Polymorphisms rs3757318 and Vitamin D Deficiency in Iraqi Breast Cancer Patients
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Abstract<sec> <title>Background:

Multiple single-nucleotide polymorphisms (SNPs) located in the intergenic region between estrogen receptor 1 and CCDC170 (especially at rs3757318) are thought to be associated with breast cancer risk. additionally, the serum level of vitamin D is believed to be linked to different aspects of breast carcinogenesis.

Objectives:

To assess the potential association between rs3757318 SNP and breast cancer pathogenicity, specifically in relation to serum vitam

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Publication Date
Fri Jan 01 2021
Journal Name
Biochemical Cellular Archive
detection of anti-helicobacter pylori cag a antibody in sera of patients with eye diseases
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The study conducted to investigate the association between Helicobacter pylori infection and eye diseases (Glaucoma, Cataract, CSR and Uveitis). One hundred and four patients with multiple eye disorders (10-80) years were observed from 10/9/2020 to 18/11/2020 and compared to thirty-one healthy people (19 female and 12 male). Each participant was tested for H. pylori CagAAbs and TNF-α using an enzyme-linked immunosorbent assay (ELISA). The results have shown that there was a non-significant difference (p≥0.05) in the concentration of CagAantibodies in sera of patients with eye diseases except in the case of CSR (central serous chorioretinopathy), which was a significant difference (P≤0.05) compared to the control group. Also, the result

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Publication Date
Tue Dec 01 2015
Journal Name
Journal Of Economics And Administrative Sciences
Measuring Service Delivery Orientation For Doctor and patients Perspective Experimental Study in Numan General Hospital
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This research aims to Measurement provide the service from Two perspectives The first perspective Service Provider (doctors) and the second recipient of the service (patients) in Numan General Hospital, and represented the research problem in perceptions of medical staff in the hospital assigned to them responsibility by providing superior services satisfy customers, and how they maintained ready to assist customers and provide services that exceed their perceptions of these services through the use of the developer scale by (Frimpong and Wilson, 2012), includes orientation to provide the service scale four dimensions (Internal cooperative behaviors, service Competence, Service Responsiveness and Enhanced service) and includes do

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Publication Date
Thu Jun 15 2023
Journal Name
Journal Of Baghdad College Of Dentistry
The Effect of titanium dioxide nanoparticles on the activity of salivary peroxidase in periodontitis patients
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Background:The technology of nanoparticles has been expanded to many aspects of modern life. Titanium dioxide nanoparticles were of many nanomaterials utilized in biomedical applications. The interactions between nanoparticles and proteins are believed to be the base for the biological effect of the nanoparticles. The oxidation reaction of many substances is catalyzed by oxidizing enzymes called peroxidases. The activity of salivary peroxidase is elevated with periodontal diseases. the aim ofthis study is to examine the action of titanium dioxide nanoparticles on salivary peroxidase activity.Material and method75 participants were enrolled in this study—Periodontitis group with 44 participants and the non-periodontitis group with 31 pa

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Publication Date
Sun Dec 02 2012
Journal Name
Baghdad Science Journal
Estimation Activity And Partial Purification Of Leucine Amino Peptidase (Lap) In Patients Wiith Diabetic Nephropathy
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Leucine aminopepotidase (LAP)[EC:3.4.11.1] activity has been assayed in (50) serum samples of patients with diabeties naphrophathy D.N (non-insulin dependent diabetic (NIDD) , and (50)serum sample of healthy individuals without any clinically detectable diseases have been as control group. The aim of this study is to measure leucine aminopeptidase activity and partially purifying the enzyme from sera of patients with diabetes nephropathy The results of this study revealed that Leucine aminopeptidase (LAP) activity of nephropathy patient’s serum shows a high signifiacant increase (p < 0.001) compared to that of the healthy subjects.LAP was purified from the serum of patients with diabetes nephropathy by dialysis and gel filtration (Se

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Publication Date
Wed Mar 29 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
The Correlation between Serum Total Adiponectin and Hemoglobin in Type 2 Diabetic Patients without Microalbuminuria
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Low serum total adiponectin is associated with a high incidence of type 2 diabetes or coronary artery disease in the general population. Paradoxically, serum total adiponectin is elevated in patients with chronic kidney disease (CKD), such as overt diabetic nephropathy. The current study aimed to investigate whether or not  anemia to be dependently associated with serum level of total adiponectin in  non-albuminuric male patients with type 2 diabetes . The study included 42 type 2 diabetic male patients. Anemia was defined as hemoglobin (Hb) below 14.0g/dL. All the patients were without microalbuminuria, to exclude diabetic nephropathy. The diabetic patients were divided into 2 groups according to the hemoglobin level in ad

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Publication Date
Mon Dec 01 2025
Journal Name
Journal Of Baghdad College Of Dentistry
An Assessment of Oral Health in Hypertensive Patients Treated with HMG-CoA Reductase Inhibitors (Statins)
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Background: Hypertension is a chronic medical condition in which the blood pressure in the arteries is elevated, it's classified as either primary (essential) hypertension or secondary hypertension, and it increases the risk of ischemic heart disease, peripheral vascular disease and other cardiovascular diseases. Several classes of medications collectively referred to as antihypertensive drugs like beta blockers, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, renin inhibitors and statins (HMG-CoA) reductase inhibitor. Statin medication may have some beneficial effects when subjects have dental plaque or signs of periodontitis as gingival bleeding. The purpose of this study were to as

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Publication Date
Wed Oct 18 2023
Journal Name
Iraqi National Journal Of Nursing Specialties
Evaluation of Nurses’ Practices Concerning Isolation Techniques for Adult Leukemic Patients in Baghdad Teaching Hospitals
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Objective: To evaluate nurses' practices concerning isolation techniques for Adult Leukemic Patients (ALP).
Methodology: A descriptive study was carried out at the isolation rooms at leukemic wards in Baghdad Teaching
Hospitals, starting from Jan. 27th 2008 up to the 27th of Apr. 2008. To achieve the objectives of study, a non-probability
"purposive" sample of (50) nurse was selected out of four Teaching Hospitals in Baghdad city were selected according
to the criteria of the study sample.
The study instrument consisted of two major parts. It is based on the review of literature. First is concerned with
demographic data for nurses; and the second part is observational tool (checklist) is composed of (83) item. The conte

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Publication Date
Fri Jan 01 2016
Journal Name
Journal Of Pharmaceutical, Chemical And Biological Sciences
Relationship between Chronic Hepatitis B Virus and Pathogenicity of Celiac Disease in the Iraqi Patients
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To determine the relationship between chronic hepatitis B virus and autoimmune celiac disease, seventy five patients with chronic hepatitis B virus of ages (8-70) years have been investigated and compared with 50 healthy individuals. All the studied groups were carried out to measure antiGliadin antibodies IgA and IgG by ELISA test and anti-reticulin antibodies IgA and IgG by IFAT. There were significant elevation (P<0.05) in the concentration of AGA IgA and IgG antibodies compared to control group. The prevalence of AGA antibodies IgA and IgG was 8% and 9.33% respectively. There were a highly significant differences (P<0.01) between studies groups. The prevalence of antireticulin antibodies ARA IgA and IgG was 6.67% and 4.0% respectively i

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Publication Date
Thu Jan 01 2015
Journal Name
World Journal Of Experimental Biosciences
Evaluation of anti-Helicobacter pylori antibodies level in sera of patients with chronic hepatitis B
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The relationship between chronic hepatitis B virus and Helicobacter pylori infection was evaluated to determine, seventy five patients with chronic hepatitis B infection (8-70 years) were investigated. The results were compared with the results of 50 healthy volunteers. Anti-H. pylori antibodies IgA and IgG were measured by Indirect fluorescent antibody test (IFAT) in sera of patients and healthy groups. The percentage of anti-H.pylori IgA antibodies (26.67%) were significantly (P<0.01) higher than healthy control group. While, no significant difference was found between the percentages of anti-H. pylori IgG antibodies (48 %) in patient sera and these kind of antibodies in sera of healthy control group (P > 0.05). The present results indica

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